- Elevance Health (Woburn, MA)
- ** Director I Medicare Operations** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles of ... Medicare and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations** is responsible for directing multiple business… more
- HealthEdge Software Inc (Boston, MA)
- …adopt digital transformation and innovation + 7+ years' experience with healthcare compliance /regulations - Medicare , Medicaid, federal and state requirements + ... Looking for a subject matter expert in the healthcare regulatory & compliance space, with acumen and passion for leveraging innovative technology to solve… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Elevance Health (Woburn, MA)
- ** Director of Contracts & Procurement** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Highmark Health (Boston, MA)
- …and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint. Designs, implements and executes strategies and works ... Organization are met and to optimize outcomes. Collaborates with the company's Medicare Advantage matrixed teams to improve processes, procedures and best practices.… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range of ... actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Prime Therapeutics (Boston, MA)
- …decision we make. **Job Posting Title** Senior Financial Analyst - Remote **Job Description Summary** This position requires significant financial analytical ... and resolving complex problems and issues. + If supporting Medicare Part D, will be responsible for implementing CMS...focus **Reporting Structure** + Reports to Manager or Sr Director in the Finance department **Responsibilities** + 3+ years… more
- Tufts Medicine (Boston, MA)
- …department or division or a large multi-site clinical study. *Fully Remote **Job Description** **Minimum Qualifications** **:** 1. Bachelor's degree **OR** High ... budgets with sponsors and assists with the completion of Medicare Coverage Analyses. 4. Keeps abreast of new and...of research program/laboratories and makes recommendations to PIs and director for planning purposes. 9. Meets regularly with … more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Provider Relations Manager - Remote **Job Description** The Manager Provider Relations is responsible for leading and ... the team through the full cycle contract management processes for Commercial, Medicare Part D, Medicaid, and Health Insurance Marketplace and the provider relations… more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Physician Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and ... review process so as to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as URAC and...+ On a requested basis, may function as Medical Director for select health plans or regions, assuming overall… more
- Beth Israel Lahey Health (Boston, MA)
- …remains current with Medicare , federal insurance and third party billing compliance regulations. Works collaboratively with the Director and coders to ensure ... codes including the appropriate use of modifiers to ensure compliance for reimbursement. **Job Description:** **Essential Responsibilities:** 1. Coordinates coding… more
- Commonwealth Care Alliance (Boston, MA)
- …Important to Us:** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance , Healthcare Medical Claims Coding ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics… more
- Takeda Pharmaceuticals (Boston, MA)
- …strategy for all payer segments in the US, including but not limited to: Medicare national (Centers for Medicare & Medicaid Services [CMS]), Medicaid (state and ... managed), Medicare Part B regional carriers, Medicare Part...activities. Specifically, work collaboratively with Commercial, Medical Affairs, Legal, Compliance , Regulatory, Government Affairs, Finance, and Insight & Analytics… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Quality and Patient Safety (QPS) Department. Under the direction of the Director of Risk Management, the Risk Manager is responsible for identification, evaluation, ... level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The...is hybrid with two or three days per week remote . The selected candidate may only work remote… more